September 29, 2012

Nigeria has consistently remained in the bad books of the civilised world following her failure to eliminate the dreaded polio disease, despite the support from the World Health Organisation, WHO, and other agencies.

Polio is the short form for poliomyelitis, an acute infectious viral disease that affects especially children. Also called infantile paralysis, in its paralytic form, the brain and spinal cord are involved, causing weakness, paralysis, and wasting muscle.

The sad end of this dangerous phenomenon is the truncated dream of the victims. The social implication is costly as most of the victims can hardly realise their potential in fending for themselves. In our environment, most of them become beggars. This is why the elimination of this disease becomes a necessity. Interestingly, the WHO had set a target for all countries of the world to eliminate polio. By 2011 only Nigeria and Bangladesh were yet to win the elimination war.

The recent report of 88 cases in 10 states in the northern part of the country suggests that our war against polio is almost becoming a mirage. The assistant director-general of the WHO, polio emergency and country collaboration, Dr Bruce Alyward, while conveying the position of the organisation, said Nigeria was not on track to achieve its polio eradication goal on time.

Alyward, who spoke in Abuja on September 11, at the 24th meeting of the Expert Review Committee on Polio Eradication and Routine Immunisation in Nigeria, said this is now the only country in the world to record polio cases consistently in the past two years and the only one with increasing cases of the virus which, he said, constitutes a real and growing international health risk.

In consonance with the WHO, we suggest that the fight against this disease must be intensified. The immunisation scheme should be invigorated all over the country, especially in the core northern states. The three tiers of government should play their roles.

LUDHIANA: The mayhem created by dengue in the city last year has forced residents to be extra cautious while fighting the disease now.

While the number of persons suffering from dengue has just crossed the 50 mark this year, the spread was far wider in 2011, when in one month alone 1,200 people were rushed to hospitals for transfusion of platelets after they tested positive for the disease.

Having learned lessons from last years shortage of blood units and aided by fewer cases this year, city hospitals claim they are ready with adequate measures. However, residents are finding it hard to fight the scare.

For instance, BRS Nagar resident Manjit Singh says recently when his relative was suspected of dengue, he made sure the platelets were available for meeting any eventuality even before the final test reports were in.

Allaying fears, Dr Sandeep Puri of Dayanand Medical College and Hospital said, "Dengue has not reached epidemic proportions this year and very few cases have been reported at our hospital. Last year, the number was huge. We have taken advanced measures and can carry out platelet transfusion on even 100 dengue patients in a day as we have seven separator machines. The hospital receives the maximum dengue cases in the city every year."

Thanks to Dr. John Carroll for tweeting the link to this Miami Herald report by Jacqueline Charles: A judicial crisis erupts in Haiti. It's a political story, but politics can affect public health in many ways. Excerpt:

While Haiti President Michel Martelly and Prime Minister Laurent Lamothe made the rounds in New York this week, a judicial crisis erupted at home with the firing of a chief prosecutor, the swearing-in of another and an alleged resignation in less than 24 hours.

Former Chief Prosecutor for Port-au-Prince Jean Renel Senatus said Haiti’s Justice Minister Jean Renel Sanon fired him Thursday because he refused to execute an order to arrest 36 government opponents.

Senatus also said that Josue Pierre-Louis, a presidential legal advisor and head of the six-member electoral council, asked him to serve warrants against two attorneys — Newton St. Juste and Andre Michel — who have brought corruption complaints against the presidential family and members of Haiti’s government.

“I told him, ‘No, I don’t have a case against them in my hand,’ ’’ Senatus said. “It’s not democratic. It’s not democracy.”

LAHORE: The Cuban government and dengue experts have offered their expertise and technical assistance to the Punjab government to help control outbreak of deadly disease in the provincial capital.

“We have offered our services in the form of technical assistance, technology transfer and use of larvicide Bti (Bacillus thuringiensis israelensis),” Cuban vector expert Dr Aramis Martínez Arias told Daily Times in an exclusive interview.

Dr Arias, who was accompanied by LABIOFAM Director Dr Jorge Luis Martínez López, said the objective of their visit to Pakistan was to share knowledge on dengue control with government officials and other stakeholders and formally offer Cuban government’s support to the Punjab government in this regard.

Dr Arias, who is a microbiologist having 20 years of experience in the field of dengue and malaria control, said, “You spray thousands of time in the city and it wouldn’t impact because the best time to kill dengue is the larvae stage. In order to control dengue outspread, strong political will, intersectoral collaboration, law enforcement and community mobilisation is needed. If you don’t combine these four principles, you cannot control dengue,” he said.

“Once hatched, it becomes very difficult to locate mosquitoes and kill them. You can use chemical sprays in areas where mosquitoes are found in a large number,” Dr Arias said.

He said role of entomologist is very important in controlling dengue outbreak.

“You can use chemicals [to kill mosquitoes] to a certain limit because this also affects environment. Therefore, you have to use biological treatment in the form of larvicide Bti,” Dr Arias said.

To a question, he said lifetime of a dengue mosquito is 30-45 days depending on environment. He said that he had been working extensively in South America and all over Africa in collaboration with WHO and governments to offer his expertise and consultancy in vector control.

Dr Arias and Dr López said they had received good response during their meeting with Punjab government’s focal persons of dengue control, including Dr Waseem Akram and Khawaja Salman Rafique.

They said they had shared their knowledge and experience with Pakistani experts and managers of the anti-dengue campaign.

Last year it was sprouts that sickened some 4,400 and killed 53 in an outbreak centered in Germany; now the number of children that have fallen ill with vomiting and diarrhea after eating food from school cafeterias and daycare centers has risen from about 4,500 to 8,400.

WHO has published the Global Health Expenditure Atlas for 2011, and it is an eye-opener. You should download the PDF and plan to spend a little time exploring it, especially the data for your own country and region.

My own experience in running this blog is that an awful lot of stories deal with awfully poor countries. The WHO report tends to confirm that impression. Here are a few numbers from the report's global overview:

Country with highest out-of-pocket household spending on health: Switzerland ($2,412)

Country with lowest out-of-pocket household spending on health: Kiribati ($0.20)

Average per-person health spending in OECD countries: $4,380

Percentage of world population living in OECD countries: 18%

Percentage of world total financial resources devoted to health currently spent in OECD countries: 84%

WHO estimate of minimum spending per person per year to provide basic services: $44

Number of WHO member states spending less than $50 per person (including external donations): 34

Number of WHO member states where health spending is less than $20 per year: 7

Percentage of funds spent on health in WHO Africa region provided by donors: 11%

Most of the report's country statistics are from 2009, and they show some striking disparities. In the Americas, for example, the top three countries for health spending are the US ($7,960), Canada ($4,519) and the Bahamas ($1,741). After that, everyone else is in three or even two digits. Examples:

The Southeast Asian region also has some surprises: India is scarcely better than Haiti, at $44. Bangladesh spends only $21, and Myanmar just $14. (North Korea is a blank.)

The Western Pacific region ranges from Australia ($3,945) and Japan ($3,754) and New Zealand ($2,702) to China ($191), Papua New Guinea ($44), Cambodia ($41), and Laos ($39).

Some oil-rich Middle Eastern countries spend surprisingly little: Qatar ($1,612), Kuwait ($1,579), and Saudi Arabia ($608). Other countries in the region spend appallingly little: Pakistan can build nuclear weapons, but spends only $20 on health. Afghanistan is well ahead at $34. And Syria, well before the current civil war, was spending only $95 a year on each citizen's health.

In 2009 Europe had the world's top health spender, Luxembourg ($8,262). You don't go into just three digits until you look at the fringe nations like Estonia ($967) and Belarus ($311). In Central Asia, Tajikistan is at the bottom with $44.

Africa is a continental disaster. Enormous Nigeria spends only $67, Ghana fights cholera with $54, and Uganda battles Ebola and nodding syndrome on $44. The Democratic Republic of Congo, with continuing civil war, cholera, and another strain of Ebola, spends $17 per person. Zimbabwe, like North Korea, doesn't provide data.

We seem to be facing a chicken-and-egg problem: Until these poor countries gain some wealth, they will continue to endure (and export) endless disease. And until their populations are healthy, wealth will be very hard to acquire. Meanwhile, climate change and political unrest will make public health and wealth even harder to achieve.

KANPUR: Four more children died of mystery fever at Lala Lajpat Rai hospital here on Friday. Meanwhile, four more cases of dengue have been reported from GSVM Medical College during the past two days, taking the total number of dengue cases in the past three weeks to 21.

Vashok, Sania, Kashish, and Abhishek, all infants below the age of three years died at the paediatric ward of LLR on Friday.

Children form the majority of deaths reported due to mystery fever at the hospital. According to hospital sources, at least 200 patients are admitted in the medical ward and there is a daily deluge of patients in at the pediatric ward as well.

Dr UC Sinha, chief medical superintendent at Ursala Horseman hospital informed that since Monday, 5000 patients have been visiting the OPD daily, among which only 100 or so are complaining of fever.

He said this number was around 300 to 500 in the second and third week of September.

A hat-tip to Ronan Kelly at FluTrackers for this story (and some useful comment).

Update: I see that almost two years ago, I posted an item on "mystery fever in Kanpur." Some things never change.

No cross-reactivity was observed with coronaviruses OC43, NL63, 229E, SARS-CoV, nor with 92 clinical specimens containing common human respiratory viruses. We recommend using upE for screening and ORF1b for confirmation.

If you live in DC’s Northern Virginia suburbs, you may have received a Romney campaign mailer vowing to eradicate Lyme Disease, “A Massive Epidemic Threatening Virginia.” At least a few incredulous residents already have, which sent the slow-news Friday media into a giggle fit.

But make no mistake, people. Northern Virginia takes Lyme seriously. As I reported this summer (see sidebar) Loudoun County has spent $20,000 soaking its public parks with high-octane pest repellent, and Governor Bob McDonnell created a statewide taskforce on the disease in 2010. Go hang out in NoVa government buildings and you’ll find Lyme pamphlets for the taking. In other words, ginning up fears about Lyme may prove to be a smart bit of retail politics. And it might also be a backdoor way of mobilizing evangelical support. Here’s how.

The claims made in Romney’s mailing, which echo an August letter he wrote to the co-chairs of the House Lyme Disease Caucus, reflect the findings of McDonnell’s taskforce. The man who chaired that taskforce, Michael Farris, is no epidemiologist. Farris is the Chancellor of evangelical Patrick Henry College, and President of the Home School Legal Defense Association.

Farris, who says his wife and seven of his ten children have the tick-borne disease, estimates that one in six Virginians are infected. (The CDC reported 756 Virginia cases in 2011.) He also argues the disease is chronic, a claim the Infectious Disease Society of America says is bogus. Experts be damned, Romney’s all ears.